No survival benefit with histology-tailored neoadjuvant chemotherapy in patients with high-risk soft-tissue sarcoma

Histology-tailored neoadjuvant chemotherapy (HT) was not associated with better disease-free or overall survival benefits compared to standard anthracycline/ifosfamide neoadjuvant chemotherapy (A+I ) in patients with high-risk soft-tissue sarcoma, according to results of a phase III trial published in the Journal of Clinical Oncology.

In this randomized, open-label, phase III trial, patients with high-risk soft-tissue sarcoma were randomized to receive 3 cycles of A+I or HT. The HT regimens consisted of trabectedin in high-grade myxoid liposarcoma; gemcitabine plus dacarbazine in LMS; high-dose prolonged-infusion ifosfamide in synovial sarcoma; etoposide plus ifosfamide in malignant peripheral nerve sheath tumor; and gemcitabine plus docetaxel in undifferentiated pleomorphic sarcoma.

At a median 52 months follow-up, the projected probabilities for disease-free survival were 47% in the HT group versus 55% in the A+I group. The projected probabilities for overall survival were 0.66 in the HT group and 0.76 in the A+I group.

The authos concluded, “In a population of patients with localized high-risk [soft tissue sarcoma], HT was not associated with a better [disease-free survival] or [overall surival], suggesting that A+I should remain the regimen to choose whenever neoadjuvant chemotherapy is used in patients with high-risk STS.”

Reference

Gronchi A, Palmerini E, Quagliuolo V, et al. Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: Final results of a randomized trial from Italian (ISG), Spanish (GEIS), French (FSG), and Polish (PSG) Sarcoma Groups. J Clin Oncol. 2020; DOI: 10.1200/JCO.19.03289.